HSE Tobacco Free Ireland Programme - HSE Tobacco Free Ireland Programme Implementation Plan 2018-2021
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HSE Tobacco Free Ireland Programme HSE Tobacco Free Ireland Programme Implementation Plan 2018-2021
HSE Tobacco Free Ireland Programme
Table of Contents
Glossary X
Foreword X
Introduction X
Context for Action X
Strategic Direction X
Targets and Outcomes 2018-2021 X
Glossary
AND Assistant National Director
CHO Community Healthcare Organisation
CYPSC Children & Young Peoples Services Committees
DoH Department of Health
EH Environmental Health
GNTH Global Network of Tobacco Free Healthcare Services
HG Hospital Group
HIQA Health Information & Quality Authority
HP&I Health Promotion and Improvement
HI Healthy Ireland
HR Human Resources
HSE Health Service Executive
KPI Key Performance Indicator
MH Mental Health
MN-CMS Maternal and Newborn Clinical Management System
NBSMS National Behavioural Support Management System
NCEC National Clinical Effectiveness Committee
NMBI Nursing and Midwifery Board of Ireland
NSP National Service Plan
SP&T Strategic Planning & Transformation
TFC Tobacco Free Campus
TFCP Tobacco Free Campus Policy
TFI Tobacco Free Ireland
TFIPG Tobacco Free Ireland Programme Group
TUSLA The Child and Family Agency (Tús Lá)
1
HSE Tobacco Free Ireland Programme
Foreword
The HSE is committed, under Action 4.5 of the Health Service Reform in Healthy Ireland, to “establish
multi-disciplinary national teams within Strategic Planning and Transformation to lead and take
responsibility for policy priority areas such as Tobacco Control, Healthy Eating and Active Living (HEAL),
Healthy Childhood, Alcohol, Wellbeing and Mental Health, Positive Aging and Sexual Health. The priority
groups will ensure appropriate governance across the organisation for these areas and ensure that
the priorities in the Healthy Ireland Implementation Plan are delivered effectively. The establishment of
Hospital Groups and Community Healthcare Organisations (CHOs) and more recently the appointment
of a Health and Wellbeing Head of Service to each of the CHO areas will facilitate the work of the
Priority Programmes. This will help to ensure that Healthy Ireland (HI) priorities are delivered across the
HSE through a collaborative approach which in turn will provide a more integrated service with better
outcomes for service users.
The main aim of the new Tobacco Free Ireland Programme is to take responsibility for and systematically
drive policy priorities in the area of tobacco control across the HSE. Ms. Martina Blake has been appointed
as lead to the Tobacco Free Ireland Programme.
2
HSE Tobacco Free Ireland Programme
Introduction
The Tobacco Free Ireland Policy Priority This national implementation plan (2018-2021)
Programme was established in late 2016 as sets out the HSE strategic direction and priority
part of the Healthy Ireland in the Health Services actions to achieve this.
Implementation Plan.1 It has a remit to:
The objectives of the Tobacco Free Ireland Policy
“mobilise the health services to Programme over the next four years are to:
improve health and wellbeing and â Prioritise the protection of children in all of our
play its part in the achievement initiatives and contribute to the denormalisation
of tobacco use for the next generation
of a reduction in smoking
prevalence to less than 5% â Support people to quit and treat tobacco
dependence as a health care issue
of the population by 2025”.
â Monitor, build and maintain compliance with
The Programme (Appendix A) works to coordinate
tobacco legislation
and lead tobacco control activity across the health
services to ensure implementation of the HSE
actions contained within the Government Tobacco
Free Ireland2 strategy.
1 Healthy Ireland in the Health Services National
Implementation Plan 2015 – 2017, Health Service
Executive, 2015.
2 Tobacco Free Ireland: Report of the Tobacco Policy
Review Group, Department of Health, 2013.
3HSE Tobacco Free Ireland Programme
Context for Action
Tobacco use is the leading cause of preventable Tobacco related morbidity and mortality accounts
death in Ireland with 5,800 smokers dying each for over 200,000 hospital episodes annually with
year from tobacco related diseases. Smoking the total cost to the health service estimated to
related deaths are mainly due to cancers, chronic be over €460 million. The total estimated cost of
obstructive pulmonary diseases (COPD) and lost productivity is over €1 billion. This comprises
heart disease. Cigarettes contain over 7000 toxic productivity lost through smoking breaks, smokers
chemicals, many of which are proven to cause taking additional absence from work and the
cancer. Smoking harms almost every organ of premature death of employed workers. The largest
the body, causing many different illnesses and proportion of the lost productivity from smoking
diseases. A long-term smoker has an average life is estimated to be from the premature death of
expectancy of approximately, 10 years less than employed individuals.4
a non-smoker. The younger you are when you
There is an ever increasing recognition among
start smoking, the more likely you are to smoke
policy makers and health service managers/
for longer and to die early from smoking.
service providers that we need to reorient our
The Healthy Ireland Survey taken in 20173 reported health services towards prevention of tobacco
a smoking prevalence of 22%, 18% daily smokers related chronic disease as these are the major
and a further 4% occasional smokers. While we drivers of healthcare costs.
have seen a reduction in youth initiation from
12.3% in 2010 to 8.3% in 2014 among the 10-17
age group (ref) there is a high level of smoking
among young adults with one in every three
25-34 year olds currently smoking.
3 Healthy Ireland Survey 2017: Summary of Findings,
IPSOS MRBI, 2017.
4 An Assessment of the Economic Cost of Smoking in
Ireland, ICF International, 2016.
4HSE Tobacco Free Ireland Programme
Smoking in Ireland Statistics
Smoking Prevalence
(Ref: Healthy Ireland Survey 2017)
22% 27%
18% daily 25% VS 20% Ex-smokers
Ireland now has more
4% occasionally
quitters than smokers
Prevalence by Age
(Ref: Healthy Ireland Survey 2017)
Age Category (Years)
19% 34% 24% 21% 20% 16%
9%
15-24 25-34 35-44 45-54 55-64 65-75 75+
*Worth noting that one in three 25-34 year olds.
Daily Exposure to Second Hand Smoke
(Ref: Healthy Ireland Survey 2017)
34% 10% 16%
Smokers Non-Smokers Population are exposed to second
hand smoke on a daily basis
5HSE Tobacco Free Ireland Programme
Attitudes to Quitting
(Ref: Healthy Ireland Survey 2017)
(Ref: Youth Smoking in Ireland, 2018)
13%
Trying
to quit
Attitude
â 57% of current smokers are 57%
42%
thinking about quitting Thinking about quitting
â Smoking rates are higher in more
16%
Thinking about
Not thinking quitting but not
deprived areas than more affluent Actively
about quitting planning to
ones. 32% of those living in the planning
most deprived areas are current to quit
smokers, compared to 16% of
those living in most affluent areas
â Current smokers were over 70%
28%
more likely to report distress
indicative of probable mental
health problems, compared to
non-smokers, independent of
age, gender and social class
â 47% of all who have smoked in
the past 12 months have made
a quit attempt
Interactions with Healthcare Professionals
(Ref: Healthy Ireland Survey 2017)
Discussed Smoking with a Healthcare
Professional in the last year Pharmacist
10%
Nurse
22%
GP
35% Hospital Doctor
Dentist
12%
20%
25% Other Healthcare
Professional
6HSE Tobacco Free Ireland Programme
Roll Your Own (RYO) Cigarettes
(Ref: Roll Your Own Report, 2017)
â Proportion of smokers using
RYO cigarettes has increased
from 3.5% in 2003 to 24.6% in
3.5% 24.6% 2014.
â Those under 25 years of age
are three times more likely
to smoke RYO cigarettes
compared to those aged
over 25.
2003 2014
Age Group
44.9%
23.9% 22.5% 24%
17.1%
8.2%
Under 25 25-34 35-44 45-54 55-64 65+
E-cigarette Usage
(Ref: Healthy Ireland Survey 2017)
7% 7%HSE Tobacco Free Ireland Programme
Disease Burden
(Ref: Nash et al. Literature Review) Tobacco Related Mortality
Cause
of Death
44% 30% 25% 1%
Cancers Cardiovascular Respiratory Digestive
Diseases Diseases Diseases
Financial Burden of Tobacco Use in Ireland
(Ref: ICF Economic Assessment, 2016)
€460m Health
Service €1.6bn Exchequer €9bn Loss of Welfare from
Morbidity & Mortality
Cost to Health Services
€171m €13m €15m €10m €256m
Hospital Hospital Hospital Hospital Primary Care
Inpatient Day Case Outpatient Emergency
Admissions Appointments Appointments Department
Attendances
Tobacco Free Ireland Strategy
(Ref: Tobacco Free Ireland 2013)
1 Five Key Areas 5
Provide leadership – policy,
practice and clinical
for Action Monitor tobacco
use and prevalence
and evaluate the
2 4 effectiveness of
Protect children through
3 Treat tobacco interventions
denormalisation of tobacco dependence as a
Regulate the retail
use and promotion of tobacco care issue
environment and monitor
free environments legislative compliance
8HSE Tobacco Free Ireland Programme
Determinants of Smoking
A range of socio-demographic, environmental, behavioural and personal indicators predict the likelihood
of adopting or rejecting smoking, particularly in early adolescence (90% of initiation to adult smoking
commences in adolesence (ref)). A decision to smoke leads to trialling the behaviour, and the resulting
experience is mediated by each of the three major streams of influence – the personal, the social setting
and broader expectations and attitudes.
ENVIRONMENT
â Exposure to â Adult smoking prevalence
Tobacco environment
Community norms
tobacco marketing
â Restrictions on smoking
â Images of smoking
in popular media
â Attitudes to youth and
youth culture
â Tobacco industry
â Socio-economic and
â Access cultural context
â Price
EXTRINSIC FACTORS INTRINSIC FACTORS
Family Personal beliefs
influences First try and values
â Parental smoking â No risk in trying
â Sibling smoking â It won’t happen to me
â Parental values and Experimentation â Curiosity
attitudes re
â Individual choice
smoking
â Adulthood aspirations
â Socio-economic
status
‘Social’ Regular â Perceptions of
smoker smoker smoking norms
â Risk-taking propensity
â elf-esteem/self-image
Cessation
Psychosocial
influences Personal
physiological factors
â Peer affiliations and Resumption â Genetics
friendships of smoking
â In utero exposure
â Connectedness to
school and/or home â Puberty and
adolescence
â Sense of alienation
Adult Adult
non-smoker smoker
9HSE Tobacco Free Ireland Programme
Strategic Direction
Improving the health and wellbeing of Ireland’s support people to stay healthy and well, reduce
population is a national priority and a key element health inequalities and protect people from threats
of healthcare reform. As part of this reform and to their health & wellbeing. The vision is to support
in response to an unsustainable level of chronic every individual and sector of society to play their
disease among our population, the Healthy part in achieving a healthy Ireland through;
Ireland (HI) Framework was adopted by the Irish
1. Reducing Chronic Disease – the biggest risk
Government in October 2013. The Healthy Ireland
to our population’s health and our services
Framework draws on existing policies but proposes
new arrangements to ensure effective co- 2. System Reform – ensuring that we deliver
operation, collaboration, to implement evidence- the significant reforms which are underway
based policies at government, sectoral, community to support a better health system
and local levels. It is about each individual 3. Staff Health and Wellbeing – ensuring we
sector helping to improve health and wellbeing, have a resilient and healthy workforce
multiplying all efforts and delivering better results.
It proposes a necessary shift towards a broader,
more inclusive approach to governance for Tobacco Free Ireland
health, moving beyond the health service, across National Policy
national and local authorities, involving all sectors
of society, and the people themselves. Healthy The Department of Health published the Tobacco
Ireland describes supportive mechanisms to Free Ireland Policy in 2013 and is the successor to
ensure effective co-operation between the health the previous National Policy Towards a Tobacco Free
sector and other areas of Government and public Society. The policy sets out the plan for the future in
services concerned with social protection, children, achieving the goal of reducing smoking prevalence
industry, food safety, education, transport, housing, to less than 5% by 2025. It is estimated that in order
agriculture and the environment. to achieve this target by 2025, in excess of 55,000
smokers will have to quit each year for the next
The Health Service commitment to the delivery of ten years5. The policy document makes sixty three
Healthy Ireland is reflected in its Healthy Ireland recommendations for cross governmental and non-
Implementation Plans across the CHOs and
governmental organisations, including a number of
Hospital Groups. The Strategic Planning and
recommendations for the health sector. It is about
Transformation Office is responsible for driving this
each individual sector helping to improve health and
agenda across the entire health service. There is
wellbeing, multiplying both our efforts and our results.
an ongoing shift in focus towards a prevention
agenda, where all services have a requirement to
10HSE Tobacco Free Ireland Programme Targets and Outcomes for the HSE Tobacco Free Ireland Programme 2018-2021 It is recognised that achieving the population This HSE Tobacco Free Ireland strategic level outcomes and targets will be the result of Implementation Plan acknowledges that it has a the cumulative impact of the sixty three specified role to play in the delivery of a Tobacco Free Ireland actions in Tobacco Free Ireland. In this context, the (
HSE Tobacco Free Ireland Programme
Measureable outcomes
The principle source of information is the Healthy Ireland Survey, which through repeated cross sectional survey of a representative sample
of the population provides for tracking of smoking prevalence, quitting intentionality and quitting behaviour. It provides insights across
key population groups, but is not useful for tracking at CHO or HG level. However, in relation to other areas and population groups, it
should be noted that there are limitations to the existing routine information systems that are currently used to report on key aspects
of the HSE Tobacco Free Ireland Programme Plan. Regarding smoking in pregnancy, there is currently no routine information system.
The Growing Up In Ireland survey has some utility. A new maternity information system combined with a new behavioural management
system will help. Likewise, smoking among people with mental health problems is not trackable through routine information.
A comprehensive research programme and secondary analysis is useful in that regard and forms part of this programme plan.
Outcome
A sustained downward trend in the levels of tobacco use in the general population in children and young people, in pregnancy
and those with Mental ill health.
Target
Overall Target 5% smoking prevalenace by 2025 as indicated in cross governmental TFI strategy. The HSE does not take
responsibility for reaching the 5% target. It is envisaged however that the range of actions outlined within this strategy will
contribute to an incremental reduction in smoking prevalence in support of the DOH goal for a Tobacco Free Ireland by 2025.
Inputs Output Measures Outcome Measures Baseline (2017)
QUIT campaign aimed at Targeted, dynamic multi-media Decrease in prevalence of 22%
overall population awareness plan: tobacco use.
and understanding of risks Monitoring, evaluation and
of tobacco and benefits of tailoring of messaging, media
quitting. and timing as required across
search, social, digital and
traditional media (including
public relations)
Increased website visits during October/November 2017
active media bursts. Clear media burst resulted in 89%
tracking of activity. increase in sessions on QUIT.ie
Omnibus and specific
research on target audiences
where required.
Increase prevalence of positive 57% of smokers are at
quit intentions. leastthinking about quitting
Increase prevalence of quit 42% of current smokers have
attempts particularly among made a quit attempt in the
men aged 25-44. past 12 months
Ongoing measurement and 16,820 during 2017
understanding of QUIT sign
ups online.
No. of clients who contact 2,914 during 2017
QUIT Freephone.
Visits to website. 245,430 during 2017
Redevelopment of QUIT Redevelopment of QUIT Ongoing measurement
website website in line with HSE digital and understanding of user
roadmap and to maximise experience on QUIT.ie
QUIT sign ups
Closed Facebook groups Signups to closed Facebook To be piloted
created, piloted, moderated group and completion of
and evaluated closed Facebook programme
12HSE Tobacco Free Ireland Programme
Inputs Output Measures Outcome Measures Baseline (2017)
Introduction of user feedback No. of referrals to intensive No existing data
on QUIT.ie cessation support by health
professionals annually
No. of self-referrals to intensive No existing data
cessation support
No. of clients receiving 11,952
intensive cessation support
through HSE services
Brief intervention for No. staff trained in MECC No. of clients from specific
smoking cessation through online modules. population groups receiving
implementation of Making No. staff trained in skills to intensive cessation support
Every Contact Count training practice module through HSE services (Pregnant,
those with mental ill health,
No. non-HSE staff trained
men, youth and low SES)
No. undergrad health
Increase proportion of clients No existing data
professional trainees trained
who discussed a quit attempt
with a healthcare professional
to 40% for GPs 35%
to 35% for hospital doctors 25%
to 25% for nurses 22%
to 20% for other health 12%
professional
Development of clinical Clinical guidelines developed, Increase in no. smokers within 47% of all who have smoked
guidelines for the identification, stakeholder consultation the last 12 months who have in the past 12 months have
diagnosis and treatment of complete, guidelines endorsed stopped smoking for one day made an attempt to quit
tobacco dependence by Minister for Health and or longer because they were
published trying to quit
Reduction in no. people who 18% daily smokers
smoked tobacco products 4% occasional smokers
daily and occasionally by
0.5% prevalence per year
(interdependent on DoH measures)
On-going implementation and Implementation and on-going TFC Policy implemented in 63% Mental Health Approved
monitoring of HSE Tobacco monitoring of HSE Tobacco 100% Mental Health Approved Centres
Free Campus Policy in HSE Free Campus Policy in 100% Centres 38% Mental Health Residential
services HSE services Centres
100% Mental Health
Residential Centres 63% Older Persons Services
100% Older Persons Services 49% Disabilities Services
100% Disabilities Services 100% Primary Care Settings
100% Primary Care settings
On-going monitoring and No. test purchases carried out % increase in compliance with 429 (90% compliance)
enforcement of tobacco sale of tobacco products to
legislation minors
No. smoke free workplace % increase in compliance with
legislation inspections carried out smoke free workplace legislation
Youth Initiation and Prevalence Reduction in no. children who 16%
have tried smoking
Reduction in no. children who 8.3%
have tried smoking monthly or
more frequently
13HSE Tobacco Free Ireland Programme
Actions, Measures and Deliverables
Theme 1:
Provide Leadership for the implementation of the HSE elements of Tobacco Free Ireland
TFI Policy Action Identified Proposal for “HOW” this will be met
Action
1.1 1 Support effective implementation of the Tobacco Free Ireland Priority Programme National
National Healthy Ireland and Tobacco Free Implementation Group will identify & agree priorities
Ireland Action Plan (DoH) and ensure the for National Service Plan/Operational plans and
Tobacco Free Ireland Programme priorities support delivery of same across the CHOs and
are included in the National Service Plan hospital groups.
and relevant annual operational Plans.
1.2 Develop a suite of Key Performance Work with Strategic Planning and Transformation
Indicators to: and the Performance and Planning Unit and service
a) Monitor impact of HSE delivered or representatives to propose, review and quality
funded interventions, programmes and assure NSP, operational plans and KPIs. Examine
services existing tobacco related KPIs and develop new
KPIs to monitor performance.
b) Monitor delivery of this Implementation
plan Engage with HI Governance group and HSE HI
Office to support inclusion of and delivery of the
TFI actions across the CHOs and Hospital groups.
1.3 Identify resource implications to deliver TFI Draft annual PIDs for operational activities and new
actions contained within this plan. projects based on programme.
Prepare business cases and funding estimate bids
and approve at TFIPG.
1.4 Engage with international health colleagues Membership of the Global Network of Tobacco Free
to share learning and experiences in the Healthcare Services (GNTH).
implementation of quality standards in
relation to tobacco management. Participation in Global Network conferences and
forums.
Participation in development and hosting of World
Conference on Tobacco and Health in 2021 with
the DoH.
1.5 10.1 Government Departments and state Ensure on-going engagement via: TACU within the
agencies including the Health Service DOH, state agencies and NGOs and the Tobacco
Executive will continue to liaise and work with Control Partners group.
non-governmental organisations in order to On-going monitoring of cross governmental strategic
achieve policy aims set out in this plan. public policy consultation processes.
14HSE Tobacco Free Ireland Programme
Deliverables Responsible Time Frame
Commence Complete
Annual priority actions and key performance TFI Programme Team and TFIPG 2018 Annual
indicators identified and agreed and included in the 2021
National Service Plan and relevant divisional service
operational plans.
Suite of KPIs identified. TFI Programme Team, HI lead, CHO/ 2018 Annual
KPI review and monitoring sub group of TFIPG Hospital Group representatives 2021
Group established.
Annually agreed KPIs in NSP and Operational Plans.
TFI actions included in CHO and hospital group
Healthy Ireland plans.
PIDs drafted for all new tobacco activities annually. TFI Programme Team 2018 Annual
Annual funding estimates bid drafted and 2021
brought to Leadership/DoH through Planning
and Performance.
Participation in or coordination of International TFI Programme Team 2018 Annual
tobacco events to support the Tobacco Free 2021
Ireland agenda.
Participation in international research/events and
the GNTH to promote quality standards.
Partners group established under the Tobacco Free TFI Programme Team 2018 Annual
Ireland Programme. 2021
Three annual meetings and on-going collaboration.
TFI Programme submits feedback to cross
governmental policy consultation processes to
embed tobacco control actions in future planning.
15HSE Tobacco Free Ireland Programme
Theme 2:
Protection of children in all of our initiatives, denormalise tobacco use for the next generation and
promote tobacco free environments.
TFI Policy Action Identified Proposal for “HOW” this will be met
Action
2.1 7.1 The protection of children must be Work with Tusla to support the development of a
prioritised in all of the initiatives outlined in policy for the protection of children from second hand
the policy. smoke in foster care homes and all levels of care.
2.2 7.5 Promote tobacco free campuses for all Work with the DOH and a corporate partner to
healthcare governmental and sporting develop a tobacco free campus toolkit for all types
facilities in consultation with key of workplaces.
stakeholders.
Work with LCDCs and CYPSCs to promote tobacco
free public spaces and environments for children.
2.3 7.2 Denormalisation must be a complimentary Work with the Department of Education and Science
underpinning theme for all of the initiatives and partners to develop the tobacco elements of the
within the policy. revised SPHE junior cycle curriculum.
2.4 7.2/7.5 Engage internally with CHOs/ Engage with the Mental Health and Social
Hospital groups and externally with Care national offices to support the successful
relevant stakeholders to ensure that implementation of the HSE TFC Policy.
denormalisation is a complementary
underpinning theme for all initiatives.
2.4.1 Engage with HIQA and MH Commission in a formal
way to lobby for inclusion of TFCP as part of their
audit criteria.
16HSE Tobacco Free Ireland Programme
Deliverables Responsible Timeframe
Commence Complete
Engage with TUSLA to advocate that they prioritise TFI Programme Team 2019 2021
the development of a policy to protect children
from second hand smoke in all levels of care and
support them in this process.
Generic Tobacco Free online toolkit developed. TFI Programme Team/DoH 2018 2018
Guidance document developed for LCDCs to TFI Programme Team 2018 2018
promote tobacco free environments, promote
denormalisation and signpost to local cessation
supports.
Input provided at LCDC forums. 2018 2021
Tobacco elements included in the SPHE junior TFI Programme Team/SP&T Education 2018 2018
cycle curriculum. Programme Manager
TFC targets set and agreed for each service area TFI Programme Team/TFIPG 2018 2019
within each CHO/Hospital group. CHO Representative
Acute Service Representative/Mental
Implementation status monitored at service/ Health Representative/Social Care 2018 2021
operational level. Representative
Guidance tools and resources for implementation 2018 2019
in specific service areas developed.
Workshops/conference/events planned & delivered 2018 2021
to support quality improvement/monitoring of TFC
policy.
HIQA/MH Commission supported to include TFC TFI Programme Team/Quality 2018 2018
policy and the treatment of tobacco addiction as Improvement
part of their audit criteria.
17HSE Tobacco Free Ireland Programme
TFI Policy Action Identified Proposal for “HOW” this will be met
Action
2.4.2 Work with HR to progress tobacco free Ireland
objectives.
2.4.3 Develop a tobacco free campus policy communications
campaign targeting service users the public and staff.
2.4.4 Work with Quality Improvement/Quality Assurance
and Verification to progress and embed TFC policy
in their routine audits and their quality improvement
processes.
2.4.5 Engage with National Estates Office to incorporate
TFC policy provisions in the development of all new
sites and buildings.
2.5 9.5 Undertake a social marketing campaign Communications to review social marketing campaign
(DOH funding dependent) focusing on the developed in relation to second hand smoke (SHS).
risks to children from exposure to second-
hand smoke with particular reference to
smoking in cars.
2.6 Engage with partner agencies and youth Work with partner agencies i.e. Spunout and ICS to
organisations to address tobacco control develop targeted tobacco control programmes to
among youth. support cessation/prevent initiation.
2.6.1 Review and publish ‘Quit 4 Youth’ training resources.
18HSE Tobacco Free Ireland Programme
Deliverables Responsible Timeframe
Commence Complete
HR representative nominated to TFIPG. SP&T/TFIPG/HR 2019 2021
HR representatives to lead the revision of the TFI Programme Team/HR/all divisions
National TFC Policy.
HSE tobacco free campus policy reviewed, revised
and signed off.
Communicate the revised policy to all levels of
management and staff.
Suite of TFC communication tools developed and Communications/TFI Programme Team/ 2019 2021
implemented. CHOs/HGs
TFC is included in quality improvement practice/ TFI Programme Team/Quality 2020 2021
protocols. Improvement/Quality A&V
TFC policy implementation is audited either
independently or is done as an integral part
of a service audit on a two year basis.
TFC policy provisions routinely incorporated in new TFI Programme Team 2019 2021
estate projects/public-private partnerships as part
of the tender process.
Communications will promote the SHS campaign Communications 2019 2021
through social media channels. A specific focus will
be given to the risks to children from exposure to
SHS.
Tobacco content on Spun out website developed TFI Programme Team/HP&I/Spun out/ICS 2018 2020
and monitored on an on-going basis.
Youth organisations supported to develop a youth
tobacco control advocacy forum.
Quit 4 youth reviewed and published. HP&I 2018 2018
Training programme to support resource developed 2019 2021
and training delivered.
19HSE Tobacco Free Ireland Programme
Theme 3:
Legislative compliance and regulating the retail environment
TFI Policy Action Identified Proposal for “HOW” this will be met
Action
3.1 8.2 Continue to promote compliance with all Identify this action in the HSE Annual Service Plan.
provisions of the Public Health (Tobacco)
Act 2002 as amended particularly the
workplace legislation.
3.2 8.3 Develop capacity within the HSE’s Enforcement, compliance levels & legislative
Environmental Health Service to maintain provisions reviewed.
consistent and sustained enforcement of all Non-compliant businesses/services targeted.
aspects of the tobacco control legislation.
3.3 9.6 Monitor the effectiveness of the current Joint DOH TACU and HSE group to review all
tobacco free legislation, including the review tobacco control legislation quarterly.
of existing exemptions and the monitoring
of compliance with these provisions.
3.4 8.4 Develop special investigation capacity The reconfiguration of the Environmental Health
within the HSE’s Environmental Health Service will consider this recommendation.
Service to assess compliance by tobacco
and E-cigarette manufacturers.
3.5 9.19 Monitor the implementation of regulations Joint DOH TACU and HSE group to review all
for pictorial warnings. tobacco control legislation quarterly.
3.6 9.22 Review existing legislation to ensure that it is Joint DOH TACU and HSE group to review all
fit for purpose to deal with new and emerging tobacco control legislation quarterly.
measures and marketing programmes
adopted by the tobacco industry.
3.7 9.28 Examine and monitor the existing tobacco Joint DOH TACU and HSE group to review all
legislation to ensure that it is inclusive of tobacco control legislation quarterly.
contemporary forms of communications.
20HSE Tobacco Free Ireland Programme
Deliverables Responsible Timeframe
Commence Complete
Data to be inserted here. AND Environmental Health 2018 Annual
2021
Annual review of national enforcement and AND Environmental Health 2018 Annual
compliance levels completed. 2021
Standard operational protocols reviewed annually.
Convictions published quarterly on the HSE website. AND Environmental Health 2018 Annual
2012
Included as a composite part of the developing AND Environmental Health 2018 Annual
National Tobacco Control Operational Unit. 2021
Survey and report on combined warnings on a AND Environmental Health 2018 Annual
cohort of cigarettes developed by revenue (illicit 2021
trade).
Follow up of review of EU manufacture, presentation AND Environmental Health 2018 Annual
and sale of tobacco and related products complete. 2021
Regulations 2016 reviewed and amendments
proposed to DOH in order to satisfy the
requirements of directive 2014/40/EU.
Legislation reviewed quarterly. AND Environmental Health 2018 Annual
2021
21HSE Tobacco Free Ireland Programme
Theme 4:
Treat tobacco dependence as a health care issue
TFI Policy Action Identified Proposal for “HOW” this will be met
Action
4.1 9.7 Identify a lead person with clear lines TFI Programme lead to liaise with HP&I to identify
of responsibility for the coordination of a lead for cessation services.
smoking cessation services within the health
service to ensure a national approach.
4.2 9.8 Develop comprehensive national smoking Complete an assessment of the delivery of tobacco
cessation guidelines. These to include the cessation services in HSE and develop a model for
minimum level of service provision that each service delivery.
service provider needs to have in place.
4.3 Review existing national standards for the intensive
cessation support Programme and publish
renewed standards.
4.4 Develop Clinical Guidelines for the Develop guidelines in line with NCEC processes
Identification Diagnosis & Treatment and publish.
of Tobacco Dependence.
4.4.1 TFI Programme Team to complete clinical guideline
training.
4.4.2 Establish a Clinical Guideline consultation group
within the HSE and externally.
4.4.3 Prioritisation submission made by Guideline
Development Group to NCEC.
4.4.4 Review existing national/international guidelines
and draft/adapt or amend for the Irish setting.
4.4.5 Undertake extensive internal and external
stakeholder consultation.
4.4.6 Amend guidelines post consultation and submit
to NCEC.
4.4.7 Publish endorsed guidelines.
4.5 Develop Implementation and communication Review national/international implementation plans
plan for the introduction of the final guideline for other guidelines and draft/adopt or amend for
for the identification, diagnosis and treatment the Irish setting.
of tobacco dependence into the clinical setting.
4.6 9.11 Train all frontline healthcare workers to Support the work of the MECC project team through:
deliver interventions for smoking cessation active participation in MECC oversight group
as part of their routine work. and working groups; providing behaviour change
support tools and resources for smoking cessation.
Provide and agree content for MECC tobacco module.
22HSE Tobacco Free Ireland Programme
Deliverables Responsible Timeframe
Commence Complete
Lead in Place. HP&I AND 2018 2018
Assessment of tobacco cessation service complete. HP&I supported by TFI Programme Team 2019 2020
Model for service delivery for standard service and
for services targeted at special interest populations
drafted and signed off (Post publication of the Clinical
Guidelines for the Treatment of Tobacco Dependence).
Standards reviewed and published. HP&I supported by TFI Team 2019 2020
Clinical guidelines quality assured by NCEC, TFI Programme Team/Clinical Guideline 2018 2020
published and endorsed by the DoH. Development Group
NCEC Clinical Guideline training completed by TFI TFI Programme Team 2018 2018
Programme Team.
Clinical guideline consultation group established TFI Programme Team 2018 2018
and convened.
Guidelines prioritised by NCEC. Clinical Guideline Development Group 2019 2018
Existing guidelines critically appraised and draft Clinical Guideline Development Group 2019 2019
guideline complete.
Stakeholder consultation completed. Clinical Guideline Development Group 2019 2019
Guideline amended following stakeholder Clinical Guideline Development Group 2019 2019
consultation and submitted to NCEC.
Guideline quality assured by NCEC and endorsed Clinical Guideline Development Group 2019 2020
by the DoH and Minister for Health.
Implementation and Communication plan drafted. TFI Programme Team/Clinical Guideline 2019 2019
Development Group/Communications
Tobacco Knowledge Reference Group established. HP&I 2018 2018
Participation in MECC oversight group. TFI Lead 2018 2020
MECC tobacco module developed, piloted, amended TFI Programme Team/HP&I 2018 2018
and launched as part of MECC training suite.
23HSE Tobacco Free Ireland Programme
TFI Policy Action Identified Proposal for “HOW” this will be met
Action
4.6.1 Agree brief intervention training/MECC targets annually
in consultation with oversight group and TFIPG.
Continue to train health professionals in smoking
cessation.
4.6.2
4.6.3
4.7 9.9 Undertake targeted approaches for Work with the Women and Infants Programme
specific groups (C2DE), particularly young (W&IP) to develop and agree evidence based
people, lower socioeconomic groups, tobacco control actions to be included in the
pregnant and post-partum women and W&IP Action Plan.
patients with chronic disease disorders to
treat tobacco dependence.
Develop intensive cessation services which
target specific population groups:
4.7.1 Services targeting pregnant and post- Work with the HI hospital group managers/Primary
partum women Care and the Woman and Infants Programme to
advocate for the establishment of onsite cessation
services in maternity settings across Acute and
Primary Care services.
4.7.2 Work with the chronic disease clinical lead/project
manager for maternity system to advocate for risk
recording to be included in the new maternity IT
system (MN-CMS).
4.7.3 Work with Maternity services to bring about routine
carbon monoxide monitoring (CO) and referral at
specific antenatal contacts/visits.
4.7.4 Scope and deliver an action research project
across primary care and acute maternity services
to examine the effectiveness of routine CO
monitoring and intensive cessation provision/
Incentivised Quit.
24HSE Tobacco Free Ireland Programme
Deliverables Responsible Timeframe
Commence Complete
Targets agreed and included in NSP. HP&I and TFIPG 2018 Annual
2021
Health professionals trained to deliver brief interventions HP&I 2018 Annual
for smoking cessation as part of MECC training. 2021
Tobacco content incorporated in to Chronic TFI Programme Team/HP&I/Clinical 2018 2019
Disease Prevention Module for all undergraduate/ Strategies and Programmes
postgraduate health professional courses.
Continue to train a variety of staff as intensive HP&I 2018 2021
smoking cessation specialists.
Specific tobacco actions included in the W&IP TFI Programme Team/HP&I 2019 Annual
annual programme of work. 2021
Establishment of new maternity onsite cessation HP&I/TFI Programme Team/W&IP 2019 2021
services/referral pathways (funding dependant).
Provide guidance and training to maternity units to
establish services according to the HSE Standard
Treatment Programme.
Staff trained in MECC and in the specialist
cessation module for pregnancy.
Risk recording for tobacco prevalence and TFI Team/HP&I/CS&P, IT, OOCIO/W&IP 2018 2018
treatment included in MN-CMS.
Advocate for routine CO monitoring to be TFI Programme Team/HP&I 2019 2021
embedded in routine antenatal service. W&IP/CS&P
Maternity hospital networks supported to train
midwives in the completion of CO monitoring.
Business case complete and approved. W&IP/HGs/TFI Programme Team/HP&I 2019 2021
Project initiated and evaluated.
25HSE Tobacco Free Ireland Programme
TFI Policy Action Identified Proposal for “HOW” this will be met
Action
4.7.5 Services targeting smokers with Mental Work with MH national office/CHOs to implement
ill-health and monitor TFC policy in MH settings.
Work with the Mental Health national office/CHOs/
MH advocacy groups to advocate for and support
the development of onsite smoking cessation services
across acute and community mental health services.
4.7.6 Services targeting smokers in lower socio Work with ICS to progress the implementation of
economic groups the ‘We Can Quit’ cessation programme targeting
women in lower socio economic groups.
4.7.7
4.7.8
4.7.9 Review QUIT campaign to realign media buy
to target more effectively specific hard to reach
population groups.
Continue to set specific targets and monitor
throughput of hard to reach population groups to
intensive cessation services through the NBSMS.
4.8 Services targeting smokers with existing Explore with the Office of Nursing and Midwifery
chronic disease Services opportunities to progress nurse
prescribing of tobacco dependence treatments.
4.9 Establish a national database for the Develop and implement a Patient Management
collection and collation of data from all System (NBSMS) for services to standardise data
smoking cessation services. collation and facilitate electronic referral to improve
efficiencies.
26HSE Tobacco Free Ireland Programme
Deliverables Responsible Timeframe
Commence Complete
Tobacco Free Campus policy implemented in all Mental Health National Office/TFI 2018 2021
mental health settings. Programme Team/HP&I
Routine monitoring of tobacco free campus and CHO/HP&I
quality improvement processes established in MH.
New mental health onsite cessation services/ CHO/HP&I
referral pathways established.
Support delivery of the “We Can Quit” Programme ICS, HP&I/Trinity/TFI Programme Team/ 2018 2020
through HSE staff and sourcing suitable locations/ Communications
HSE venues.
Support the planning and running of a randomised HP&I/TFI Programme Team 2018 2021
cluster pilot trial of “We Can Quit”.
‘We Can Quit’ pilot trial complete and report drafted. ICS, HP&I/Trinity 2018 2020
TFI Team
QUIT campaign continually monitored to ensure it Communications/TFIP team/ HP&I
is reaching specific population groups of interest.
Specific population group targets for intensive TFIP team/HP&I/CHOs/Hospital Groups
cessation services set & NBSMS system monitored
to assess performance against targets.
Tobacco dependence treatments included in the N&MS/TFI Programme Team/NMBI/ 2020 2021
list of medications for chronic disease specialist Clinical Guideline Development Group/
nurses. W&IP
Tender process complete. TFI Programme Team 2018 2019
Contract drafted and signed between HSE and HP&I/Procurement
successful provider. External Provider/HP&I/ Comms/Relate
IT system developed to the required specification. Care
Pilot site identified to trial new system and one stop
referral model.
New system integrated in to existing IT systems in
acute divisions and Primary Care.
Amendments completed to system based on pilot
feedback.
Three integrations delivered between the new
National Behavioural Support Patient Management
System; Healthlink, Quit.ie & the MN-CMS.
Communications plan developed to promote the one
stop referral model to GPs/PC/MH/SC/Acute staff.
New system launched and communicated.
27HSE Tobacco Free Ireland Programme
Theme 5:
Monitor tobacco use and prevalence and evaluate effectiveness of all interventions
TFI Policy Action Identified Proposal for “HOW” this will be met
Action
5.1 9.2/9.3 Tobacco control measures should be On-going surveillance of tobacco use through
continuously evaluated to ascertain HSE Tracker Survey, Healthy Ireland and Health
impacts and outcomes. Behaviour in School Children Surveys.
Publish first and second HSE State of Tobacco
Control Report.
5.1.1 Work with services/divisions to agree targets for
completion of GNTH global online self-audit.
5.2 9.20/9.3 Tobacco control measures should be Evaluation built in to the QUIT campaign and
continuously evaluated to ascertain cessation service provision and carried out as
impacts and outcomes including the appropriate.
evaluation of campaigns and programmes.
5.2.1 Work with quality improvement and quality
assurance and verification division to progress
quality improvement in terms of TFCP
implementation and the treatment of tobacco
dependence. See Action 8.3/8.4/9.19/9.28.
5.2.2 Evaluation of cessation/Quit services.
Monitor throughput, reach of tobacco users
through National Health Behavioural Management
System.
5.2.3 Evaluation of BISC training effectiveness.
28HSE Tobacco Free Ireland Programme
Deliverables Responsible Timeframe
Commence Complete
Secondary analysis of tobacco indicators from TFI Programme Team/Public Health/ 2018 2018
HI survey, HBSC and TILDA published to build Health Information Unit
evidence for TFI.
State of Tobacco Control in Ireland Report 2018 2021
produced in 2018 and 2021.
Develop and publish HSE tobacco control research 2019 2021
and information plan (2019.)
Implement HSE tobacco control research and 2019 2021
information plan (2020-2021).
Targets for GNTH self-audit drafted and embedded TFI Programme Team/CHOs/Hospital 2018 2021
in CHO/Hospital Group Healthy Ireland Plans. Groups
Annual collation of data on the number of self-
audits completed.
Completion of monthly evaluation of digital display Communications/HP&I/TFI Programme 2018 On-going -
media. Team 2021
Completion of quarterly web statistics using
Google analytics.
Completion of You-tube tracking.
Quarterly analysis of conversion rates from digital
partnerships.
Completion of quarterly and annual audit on media
spend.
Completion of Quarterly tracking of media
coverage measurements.
Completion of monthly audit of cessation service
provision against target.
Completion of omnibus research awareness to
monitor campaign awareness and effectiveness.
Completion of monthly evaluation of social media
engagement.
Quality improvement guidance received on TFC TFI Programme Team/HP&I 2019 2020
implementation.
Monthly performance reports on throughput and HP&I/Communications/TFI Programme 2018 2021
reach of cessation services drafted. Team/ICT
BI training evaluation complete and report TFI Programme Team 2018 2018
published.
29HSE Tobacco Free Ireland Programme
Appendix A
Tobacco Free Ireland Programme Team (2018)
Programme Group (TFIPG) Role Name
An Implementation Group entitled the “Tobacco National Lead Martina Blake
Free Ireland Programme Group” (TFIPG) has
Project Manager Edward Murphy
been set up under the Tobacco Free Ireland
Programme, chaired by Ms. Martina Blake, Tobacco Free Campus Miriam Gunning
Policy Lead
Tobacco Free Ireland Programme Lead. The
group has clear terms of reference which will Administrator TFI@hse.ie
provide strategic direction for the work of the Clinical and Research Lead Dr Paul Kavanagh
Programme, monitor progress and facilitate
Communications Campaign Aoife O’ Sullivan
effective co-operation between service areas. Manager Rachel Wright
Membership of the implementation group includes
senior management from each HSE service area,
the Hospital Groups and Community Healthcare
Organisations who have responsibility for the
delivery of agreed actions within their respective
services at both a national and local level.
Tobacco Free Ireland Programme Group (TFIPG) Membership
Service Areas Represented 2018
National Lead, Tobacco Free Ireland Programme
Project Manager, Tobacco Free Ireland Programme
Tobacco Free Campus Policy Lead, Tobacco Free Ireland Programme
Clinical and Research Lead, Public Health/Tobacco Free Ireland Programme
HSE Communications
Health Promotion and Improvement National Office
Healthy Ireland National Office Lead
HSE Human Resources
Social Care – Disability Services
Social Care – Older Persons Services
Mental Health
Primary Care
National Acute Hospitals Office
Hospital Groups
Community Healthcare Organisations
Environmental Health
TUSLA
National Behavioural Support Management System Project Manager
National Cancer Control Programme
30HSE Tobacco Free Ireland Programme
Appendix B
Tobacco Free Ireland Tobacco Free Ireland Partners
Partners Group Group Membership
Partnership Working/Stakeholder Involvement Alpha 1 Foundation Tobacco Free Ireland
Programme, HSE (Chair)
Healthy Ireland places significant emphasis
ASH Ireland
on collaboration and partnership working.
Asthma Society of Ireland
The achievement of our strategic priorities is
dependent on effective partnerships internally and Athlone Institute of Technology
strong cross-sectoral engagement with external Communications, HSE
stakeholders. In some instances other agencies
COPD Ireland
and government departments are better placed to
deliver on actions which impact on people’s health Environmental Health, HSE
and wellbeing – we must proactively leverage Health Promotion and Improvement, HSE
existing relationships and forge new relationships Institute of Public Health
in pursuit of our shared agenda.
Irish Cancer Society
The Tobacco Free Ireland Partners Group is a multi- Irish College of General Practitioners
agency partnership made up of representatives
Irish Dental Association
from across non-government organisations with an
interest in Tobacco control. The aim of the group Irish Heart Foundation
is to provide a formal platform for discussion and Irish Thoracic Society
dialogue between the HSE and non-governmental National Cancer Control Programme
stakeholders on tobacco control. Ideas and best
National Women’s Council of Ireland
practice can be shared in relation to tobacco
control issues. This multi-agency working group will Pharmaceutical Society Of Ireland
also help drive, co-ordinate and support the delivery Public Health, HSE
of the priorities in the Tobacco Implementation Plan. Royal College of Physicians Ireland
SputOut
Tobacco Free Research Institute
31HSE Tobacco Free Ireland Programme
References
An Assessment of the Economic Cost of Smoking
in Ireland, ICF International, 2016.
Healthy Ireland in the Health Services National
Implementation Plan 2015 – 2017, Health Service
Executive, 2015.
Healthy Ireland Survey 2017: Summary of
Findings, IPSOS MRBI, 2017.
Tobacco Free Ireland: Report of the Tobacco
Policy Review Group, Department of Health, 2013.
Youth Smoking in Ireland: A special analysis of the
Health Behaviour in School-aged Children (HBSC)
Study, Health Service Executive, 2018.
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